Provider Demographics
NPI:1194267997
Name:AUTRY, ZACHARY R (MA, CMHC)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:R
Last Name:AUTRY
Suffix:
Gender:M
Credentials:MA, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10679 S 2200 W APT 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8340
Mailing Address - Country:US
Mailing Address - Phone:801-842-2413
Mailing Address - Fax:
Practice Address - Street 1:3148 S 1100 W
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3304
Practice Address - Country:US
Practice Address - Phone:385-468-8400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-09
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT11692670-6009101YM0800X, 101YP2500X
UT11692670-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional